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New York Phase 4 - 2002 Telephone Questionnaire 1 First, we would like to ask a few questions about you and the time before you became pregnant with your new baby. Please check the box next to your answer. 1. Just before you got pregnant, did you have health insurance? (Do not count Medicaid.)

__ No __ Yes

2. Just before you got pregnant, were you on Medicaid?

__ No __ Yes

3. In the month before you got pregnant with your new baby, how many times a week did you take a

multivitamin? (a pill that contains many different vitamins and minerals)?

__ I did not take a multivitamin at all __ I took a multivitamin 1 to 3 times a week __ I took a multivitamin 4 to 6 times a week __ I took a multivitamin every day of the week

4. What is your date of birth?

______ / _____ / _____ month day year

5. Just before you got pregnant, how much did you weigh?

______ Pounds OR ________Kilos

6. How tall are you without shoes?

______ Feet ______ Inches OR ______Centimeters

7. Before your new baby, did you ever have any other babies who were born alive?

__ No Go to Question #10 __ Yes

New York Phase 4 - 2002 Telephone Questionnaire 2

8. Did the baby born just before your new one weigh 5 pounds, 8 ounces ( 2.5 kilos.) or less at birth?

__ No __ Yes

9. Was the baby just before your new one born more than 3 weeks before its due date?

__ No

__ Yes

10. Thinking back to just before you got pregnant, how did you feel about becoming pregnant?

Check one answer __ I wanted to be pregnant sooner __ I wanted to be pregnant later __ I wanted to be pregnant then __ I did not want to be pregnant then or at any time in the future

11. When you got pregnant with your new baby, were you trying to become pregnant?

__ No __ Yes Go to Question #14

12. When you got pregnant with your new baby, were you or your husband or partner doing anything to keep

from getting pregnant? ( Some things people do to keep from getting pregnant include not having sex at certain times (rhythm), and using birth control methods such as the pill, Norplant®, shots (Depo-Provera®), condoms, diaphragms, foam, IUD, having their tubes tied, or their partner having a vasectomy.) __ No

__ Yes Go to Question #14


13. What were your or your husband’s or partner’s reasons for not doing anything to keep from getting pregnant?

Check all that apply __ I didn’t mind if I got pregnant __ I thought I could not get pregnant at that time __ I had side effects from the birth control method I was using __ I had problems getting birth control when I needed it __ I thought my husband or partner or I was sterile (could not get pregnant at all) __ My husband or partner did not want to use anything __ Other Please tell us: _______________________________________________ The next questions are about the prenatal care you received during your most recent pregnancy. Prenatal care includes visits to a doctor, nurse, or other health care worker before your baby was born to get checkups and advice about pregnancy. (It may help to look at a calendar when you answer these questions.) 14. How many weeks or months pregnant were you when you were sure you were pregnant? ( For example,

you had a pregnancy test or a doctor or nurse said that you were pregnant.)

_____Weeks OR ______Months

15. How many weeks or months pregnant were you when you had your first visit for prenatal care? ( Do not

count a visit that was only for a pregnancy test or only for WIC [the Special Supplemental Nutrition Program for Women, Infants, and Children]).

______ Weeks OR ______ Months

16. Did you get prenatal care as early in your pregnancy as you wanted?

__ No __ Yes Go to Question # 18 __ I did not want prenatal care Go to Question #18


17. Did any of these things keep you from getting prenatal care as early as they wanted. Check all that apply __ I couldn’t get an appointment earlier in my pregnancy __ I didn’t have enough money or insurance to pay for my visits __ I didn’t know that I was pregnant __ I had no way to get to the clinic or doctor’s office __ The doctor or my health plan would not start care earlier __ I did not have my Medicaid card

__ I had no one to take care of my children __ I had too many other things going on __ Other Please tell us:

_______________________________________________________________________ If you did not go for prenatal care, go , Question 22. 18. Where did you go, most of the time for your prenatal care visits. (Don’t include visits for WIC.)

Check one answer

__ A hospital clinic __ A health department clinic __ A private doctor’s office or HMO clinic __ A community health center __ Other Please tell us:

_________________________ 19. How was your prenatal care paid for? Check all that apply

__ Medicaid __ Personal income (cash, check, or credit card) __ Health insurance or HMO __ PCAP (Prenatal Care Assistance Program) __ I still owe __ Other Please tell us: ______________________________________________________


20. During any of your prenatal care visits, did a doctor, nurse, or other health care worker talk with you about any of the things listed below? (Please count only discussions, not reading materials or videos.) For each item, circle Y (Yes) if someone talked with you about it or circle N (No) if no one talked with you about it. No Yes a. How smoking during pregnancy could affect your baby N Y b. Breastfeeding your baby N Y c. How drinking alcohol during pregnancy could affect your baby N Y d. Using a seat belt during your pregnancy N Y e. Birth control methods to use after your pregnancy N Y f. Medicines that are safe to take during your pregnancy N Y g. How using illegal drugs could affect your baby N Y h. Doing tests to screen for birth defects or diseases that run in your family N Y i. What to do if your labor starts early N Y j. Getting your blood tested for HIV (the virus that causes AIDS N Y k. Physical abuse to women by their husbands or partners N Y

21. We would like to know how you felt about the prenatal care you got during your most recent pregnancy. If

you went to more than one place for prenatal care, answer for the place where you got most of your care. For each thing, circle Y (Yes) if you were satisfied or circle N (No) if you were not satisfied. Were you satisfied with--- No Yes a. The amount of time you had to wait after you arrived for your visits N Y b. The amount of time the doctor or nurse spent with you during your visits N Y c. The advice you got on how to take care of yourself N Y d. The understanding and respect that the staff showed toward you as a person N Y


22. At any time during your most recent pregnancy or delivery, did you have a blood test for HIV (the virus that causes AIDS)? __ No

__ Yes Go to Question #24 __ I don’t know

23. What were your reasons for not having an HIV test during your most recent pregnancy? Check all that apply __ I wasn’t offered the test __ I didn’t think I was at risk for HIV __ I agreed to be tested but had difficulty getting the test done __ I was afraid of getting the result __ I had already been tested and did not think I needed to be tested again Other Please tell us: _________________________________________________

24. Some health experts recommend taking folic acid for which one of the following reasons?

Check one answer

__To make strong bones __To prevent birth defects __To prevent high blood pressure

__ I don’t know

The next questions are about your most recent pregnancy and things that might have happened during your pregnancy. 25. During your pregnancy, were you on WIC,( the Special Supplemental Nutrition Program for Women,

Infants, and Children)?

__ No __ Yes


26. Did you have any of these problems during your pregnancy? For each thing, circle Y (Yes) if you had the problem or circle N (No) if you did not.

No Yes a. Labor pains more than 3 weeks before your baby was due (preterm or early labor) N Y b. High blood pressure (including preeclampsia or toxemia) or retained water (edema) N Y c. Vaginal bleeding N Y d. Problems with the placenta (such as abruptio placentae, placenta previa) N Y e. Severe nausea, vomiting, or dehydration N Y f. High blood sugar (diabetes) N Y g. A kidney or bladder (urinary tract) infection N Y h. Water broke more than 3 weeks before your baby was due (premature rupture of membranes, PROM) N Y i. Your cervix sewn shut (incompetent cervix, cerclage) N Y j. You were hurt in a car accident N Y If you did not have any of these problems, go to Question 28.


27. Did you do any of the following things because of these problem(s)? Check all that apply __ I went to the hospital or emergency room and stayed less than 1 day __ I went to the hospital and stayed 1 to 7 days __ I went to the hospital and stayed more than 7 days __ I stayed in bed at home more than 2 days because of my doctor’s or nurse’s advice 28. At any time during your most recent pregnancy, were you told to stay in bed for at least one week?

__ No Go to Question #32 __ Yes

29. How many weeks or months pregnant were you when you were told to stay in bed?

______weeks OR ______months 30. How often were you able to follow your provider’s instruction to stay in bed?

__ Always Go to Question #32

__ Almost always Go to Question #32 __ Sometimes __ Rarely __ Never

31. What type of support would have helped you to stay in bed for the recommended time?

Check all that apply __ Help with child care __ Help with housework __ Knowing I wouldn’t lose my job __ Money to make up for not working __ Other Please tell us: _______________________________________________


The next questions are about smoking cigarettes and drinking alcohol. 32. Have you smoked at least 100 cigarettes in the past two years? (A pack has 20 cigarettes.)

__ No Go to Page 6, Question #36 __ Yes

33. In the 3 months before you got pregnant, how many cigarettes or packs of cigarettes did you smoke on an

average day? (A pack has 20 cigarettes.)

____ Cigarettes OR ____ Packs

__ less than 1 cigarette a day __ I didn’t smoke __ I don’t know

34. In the last 3 months of your pregnancy, how many cigarettes or packs of cigarettes did you smoke on an average day?

______Cigarettes OR ______ Packs

__ less than 1 cigarette a day

__ I didn’t smoke __ I don’t know

35. How many cigarettes or packs of cigarettes do you smoke on an average day now?

______Cigarettes OR _____Packs

__ less than 1 cigarette a day __ I didn’t smoke __ I don’t know

36. Have you had any alcoholic drinks in the past two years? (A drink is 1 glass of wine, wine cooler, can or

bottle of beer, shot of liquor, or mixed drink.)

__No Go to Question 39 __Yes


37. a. During the 3 months before you got pregnant, how many alcoholic drinks did you have in an average week?

__ I didn’t drink then __ less than 1 drink a week

__ 1 to 3 drinks a week __ 4 to 6 drinks a week __ 7 to 13 drinks a week __ 14 drinks or more a week

__ I don’t know

b. During the 3 months before you got pregnant, how many times did you drink 5 alcoholic drinks or more in one sitting?

______ Times

__ I didn’t drink then

__ I don’t know 38. a. During the last 3 months of your pregnancy, how many alcoholic drinks did you have in an average

week?

__ I didn’t drink then __ less than 1 drink a week

__ 1 to 3 drinks a week __ 4 to 6 drinks a week __ 7 to 13 drinks a week __ 14 drinks or more a week

__ I don’t know b. During the last 3 months of your pregnancy, how many times did you drink 5 alcoholic drinks or

more in one sitting?

______ Times

__ I didn’t drink then __ I don’t know


Pregnancy can be a difficult time for some women. These next questions are about things that may have happened before and during your most recent pregnancy.

39. This question is about things that may have happened during the 12 months before your new baby was

born. For each item, circle Y (Yes) if it happened to you or circle N (No) if it did not. (It may help to use the calendar.)

No Yes a. A close family member was very sick and had to go into the hospital N Y b. You got separated or divorced from your husband or partner N Y c. You moved to a new address N Y d. You were homeless N Y e. Your husband or partner lost his job N Y f. You lost your job even though you wanted to go on working N Y g. You argued with your husband or partner more than usual N Y h. Your husband or partner said he did not want you to be pregnant N Y i. You had a lot of bills you couldn’t pay N Y j. You were in a physical fight N Y k. You or your husband or partner went to jail N Y l. Someone very close to you had a bad problem with drinking or drugs N Y m. Someone very close to you died N Y


40. a. During the 12 months before you got pregnant, did your husband or partner push, hit, slap, kick,

choke, or physically hurt you in any other way?

__ No __ Yes

b. During the 12 months before you got pregnant, did anyone else physically hurt you in any way?

__ No

__ Yes 41 a. During your most recent pregnancy, did your husband or partner push, hit, slap, kick, choke, or

physically hurt you in any other way?

__ No __ Yes

b. During your most recent pregnancy, did anyone else physically hurt you in any way?

__ No __ Yes

42. How would your describe the time during your pregnancy? Check one answer

__ One of the happiest times of my life __ A happy time with few problems __ A moderately hard time __ A very hard time __ One of the worst times of my life


The next questions are about your labor and delivery. (It may help to look at the calendar when you answer these questions.) 43. On what date was your baby due?

______ / _____ / _____ month day year

44. On what date did you go into the hospital to have your baby?

______ / _____ / _____ month day year

__ I didn’t have my baby in a hospital 45. On what date was your baby born?

______ / _____ / _____ month day year

46. On what date were you discharged from the hospital after your baby was born? It may help to use a

calendar. ______ / _____ / _____ month day year

__ I did not have my baby in a hospital

47. After your baby was born, was he or she put in an intensive care unit? __ No

__ Yes __ I don’t know


48. After your baby was born, how long did he or she stay in the hospital? __ Less than 24 hours (less than 1 day) __ 24 to 48 hours (1 to 2 days) __ 3 days __ 4 days __ 5 days __ 6 or more days

__ My baby was not born in a hospital __ My baby is still in the hospital

49. How was your delivery paid for?

Check all that apply

__Medicaid __Personal income (cash, check, or credit card) __Health insurance or HMO __PCAP (Prenatal Care Assistance Program) __I still owe __Other Please tell us:

_____________________________________________________


The next questions are about the time since your new baby was born. 50. What is today’s date?

Month _____Day ____Year______ 51. Is your baby alive now?

___ No ___ Yes Go to Question #53 52. When did your baby die?

______ / _____ / _____ Go to Page 11, Question #69 month day year

53. Is your baby living with you now?

__ No Go to Page 11, Question #69 __ Yes

54. Did you ever breastfeed or pump breast milk to feed your new baby after delivery?

__ No __ Yes Go to Question #56


55. What were your reasons for not breastfeeding your new baby? Check all that apply then go to Question 60 __ I had other children to take care of __ I had too many household duties __ I didn’t like breastfeeding __ I didn’t want to be tied down __ I was embarrassed to breastfeed __ I went back to work or school __ My husband or partner did not want me to breastfeed __ I wanted my body back to myself __ Other Please tell us: _________________________________________________

56. Are you still breastfeeding or feeding pumped milk to your new baby?

__ No __ Yes Go to page 10, Question #59

57. How many weeks or months did you breastfeed or pump milk to feed your new baby?

______Weeks OR _____Months

___ less than 1 week

58. What were your reasons for stopping breastfeeding? Check all that apply __ My baby had difficulty nursing __ Breast milk alone did not satisfy my baby __ I thought my baby was not gaining enough weight __ My baby became sick and could not breastfeed __ My nipples were sore, cracked, or bleeding __ I thought I was not producing enough milk __ I had too many other household duties __ I felt it was the right time to stop breastfeeding __ I became sick and could not breastfeed __ I went back to work or school __ My husband or partner wanted me to stop breastfeeding __ I wanted or needed someone else to feed the baby __ Other Please tell us: __________________________________________


59. How old was your baby the first time you fed him or her anything besides breast milk? ( Include formula, baby food, juice, cow’s milk, water, sugar water, or anything else you fed your baby.)

_____ Weeks OR ______ Months

__ My baby was less than one week old __ I have not fed my baby anything besides breast milk

If your baby is still in the hospital, go to Question 67.

60. About how many hours a day, on average, is your new baby in the same room with someone who is smoking?

______ Hours

__Less than one hour a day __My baby is never in the same room with someone who is smoking.

61. How do you most often lay your baby down to sleep now? Check one answer

__On his or her side __On his or her back __On his or her stomach


62. Was your baby seen by a doctor, nurse, or other health care provider in the first week after he or she left

the hospital?

__ No Go to Question #64 __Yes

63. Was your new baby seen at home or at a health care facility, such as a doctor’s office, clinic, or other health care facility?

__ At home

__At a doctor’s office, clinic, or other health care facility

64. Has your baby had a well-baby checkup?

__No Go to Question #67 __Yes

65. How many times has your baby been to a doctor or nurse for a well-baby checkup? ( It may help to use the calendar.)

______Times

66. Where do you usually take your baby for well-baby checkups?

Check one answer __A hospital clinic __A health department clinic __A private doctor’s office or HMO clinic __A community health center __Other Please tell us: _________________________

67. Do you have health insurance or Medicaid for your new baby?

__No Go to Question #69

__Yes


68. What type of insurance is your new baby covered by?) Check all that apply __Medicaid __Private insurance or HMO __Child Health Plus __Other Please tell us _____________________________________

69. Are you or your husband or partner doing anything now to keep from getting pregnant? (Some things people do to keep from getting pregnant include having their tubes tied or their partner having a vasectomy, using birth control methods like the pill, Norplant®, shots [Depo-Provera®], condoms, diaphragms, foam, IUD, and not having sex at certain times [rhythm].)

__ No

__ Yes Go to Question #71

70. What are your or your husband’s or partner’s reasons for not doing anything to keep from getting pregnant now? Check all that apply then go to Question 72

__I am not having sex __I want to get pregnant __I don’t want to use birth control __My husband or partner doesn’t want to use anything __I don’t think I can get pregnant (sterile) __I can’t pay for birth control __I am pregnant now __Other Please tell us: ___________________________________________


71. What kind of birth control are you or your husband or partner using now to keep from getting pregnant?

Check all that apply __Tubes tied (sterilization) __Vasectomy (sterilization) __Pill __Condoms __Foam, jelly, or cream __Norplant® __Shots (Depo-Provera®) __Withdrawal __Other Please tell us: _______________________________________________

72. After your new baby was born, did a doctor, nurse, or other health care worker talk with you about using birth control?

__ No

__ Yes

73. In the months after your delivery, would you say that your were Check one answer __Not depressed at all __A little depressed __Moderately depressed __Very depressed __Very depressed and had to get help

The next questions are about your family and the place where you live.

74. Which rooms are in the house, apartment, or trailer where you live? Check all that apply

__Living room __Separate dining room __Kitchen __Bathrooms

__Recreation room, den, or family room __Finished basement __Bedrooms How many? ______


75. Counting yourself, how many people live in your house, apartment, or trailer?

___Adults (people aged 18 years or older) ___Babies, children, or teenagers (people aged 17 years or younger)

76. What were the sources of your household’s income during the past 12 months? Check all that apply

__Paycheck or money from a job

__Aid such as Temporary Assistance for Needy Families (TANF), welfare, public assistance, general assistance, food stamps, or Supplemental Security Income

__Unemployment benefits __Child support or alimony __Social security, worker’s compensation, veteran benefits, or pensions __Money from a business, fees, dividends, or rental income

__Money from family or friends __Other Please tell us: ___________________________________________________

77. When you got pregnant, how old was your new baby’s father? ____ years old __I don’t know

If you did not go for prenatal care, go to Question 79.

78. This question is about things that a doctor, nurse, or other health care worker might have talked to you about when you went for prenatal care during your most recent pregnancy. For each thing, circle Y (Yes) if someone talked to you about it or circle N (No) if they did not.

No Yes a. How much vitamin A is safe to take during pregnancy N Y b. How long to wait before having another baby N Y c. The “baby blues” ( postpartum depression) N Y

79. This question is about the care of your teeth and gums during your most recent pregnancy. For each thing, circle Y (Yes) if it is true or circle N (No) if it is not true.

No Yes a. You needed to see a dentist for a problem N Y b. You went to a dentist or dental clinic N Y c. A dental or other health care worker talked with you about how to care for your teeth and gums N Y


80. How long has it been since you had your teeth cleaned by a dentist or dental hygienist?

________ months If your baby is not alive or is not living with you, go to Question 82.

81. Since your new baby was born, have you used WIC services for your new baby?

__ No __ Yes

82. Between the time you became pregnant and now, have you applied for TANF (Temporary Assistance to

Needy Families)? __ No Go to Page 14, Question #85

__ Yes

83. Did you get TANF?

__ No __ Yes Go to Page 14,Question #85

84. Why didn’t you get TANF?

__You were ineligible because of your income __You had reached your time limit __You had to fulfill work or other requirements __You had to return on another day to apply __You had previously lost TANF for another reason (administrative reasons, sanctions, etc.) __You are not a U.S. citizen __Other Please tell us: ________________________________________________


85.In the 12 months before your most recent delivery, what was your total family income before taxes? Include your income, your husband’s or partner's income, and any other income you may have had. All information you give us will be kept private

__ Less than $10,000 __ $10,000 to $14,999 __ $15,000 to $19,999 __ $20,000 to $24,999 __ $25,000 to $34,999 __ $35,000 to $49,999 __ $50,000 to $74,999 __ $75,000 or more

__ Do not know/Not sure __ Refused

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